MEDICARE: KATHRYN VASICH ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		OH

General Provider Information

NPI Number	:	1922544410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN VASICH ATC

Provider Business Mailing Address
First Line	:	6082 EMERALD ST
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2046
Country	:	US
Telephone Number	:	440-864-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	6082 EMERALD ST
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2046
Country	:	US
Telephone Number	:	440-864-7066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	01/09/2017

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